Opinion

Breastfeeding is falling between the cracks of our health care system

There is a major gap between public health messages, women’s intentions and actual practices when it comes to breastfeeding.

I’ve experienced this first hand as a new mother.  The major topic of conversation amongst new mothers tends to center around breastfeeding and ensuring that our babies’ needs are being met. Whether your baby is getting enough to eat, gaining weight and thriving are paramount concerns.

It is well documented that many women have issues with breastfeeding techniques and infant feeding. Research suggests that professional support can increase breastfeeding success and duration.

The public health message is breast is best, and that exclusive breastfeeding provides important health benefits to both babies and mothers, however there is tremendous variation within Ontario around access to breastfeeding support from qualified health care providers.

Some hospitals offer breastfeeding clinics, and have providers with training in lactation while others do not; some public health units have nurses visit new mothers within the first week of a child’s birth to offer breastfeeding support while others do not. Some primary care providers, like Community Health Centres or family practices have staff trained in lactation, but many do not.  A quick Google search reveals that there are many private lactation consultants, with varying levels of training who offer home visits for breastfeeding issues, however their services come at a steep out of pocket cost to new parents.

This lack of standardization for breastfeeding support across the province sets up many new mothers to fail when they encounter breastfeeding challenges.

The World Health Organization and Health Canada  recommend that women exclusively breastfeed babies from birth until six months of age. While over 90% of women in Canada intend to breastfeed their babies, and about 90% of women initiate breastfeeding – just over 50% are breastfeeding when their babies are six months old.

A breastfeeding problem – such babies having trouble latching, or questions about milk supply – often emerge once women have been discharged home and when their milk comes in a few days after the baby is born. Being able to coordinate the schedule of a new baby to the hours of a hospital or public health breastfeeding clinic can be difficult. In this context of a fractured system, and challenges accessing services, it is no surprise that within the first week of birth, one in five women supplement breastfeeding with formula, and one in four by the second week.

Considering the benefits of breastfeeding for infant and child health, as well as maternal health, there ought to be more readily accessible support and increased standardization to ensure breastfeeding support from the heath care system.

One approach that has demonstrated significant breastfeeding success is the midwifery model – in Ontario, midwifery clients receive six weeks of postpartum care from their midwifery team. Midwives are trained in breastfeeding support, and over 90% of midwifery clients in Ontario are exclusively breastfeeding their babies at 6 weeks post partum. Part of this model of care includes home visits to the new mother and baby within the first week of hospital discharge, and frequent clinic visits for the first six weeks after birth. Rather than having a new mother experiencing breastfeeding difficulty seeking out care, she is assured by having regular access to a provider trained in lactation support.

Leveraging from this model could help support breastfeeding success. It should be the standard of care across the province, regardless of region or birth provider, that a new mother is offered a scheduled visit with a publicly funded health care professional trained in lactation within the first week of their child’s life, along with any necessary follow-up appointment within the first six months of life.

Breastfeeding is too important for both babies and mothers to have it fall between the cracks of the health care system.

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6 Comments
  • Janice Williams says:

    Infant feeding is too important – but the amount of focus on breastfeeding in Canada today is dysfunctional to the health and well-being of both mothers and their children. No woman should feel a failure for being unable to or not wanting to breast feed. Sadly, many do. We need to take a step back and get back to what matters. Is a breastfeeding relationship worth the tremendous cost it imposes on some women?

    I would encourage the author to look at the work done by Suzie Barston in the US – author of “Bottled Up”, and writer of the Fearless Formula Feeder.

    All women’s needs deserve to be met – not just those who can or choose to breastfeed.

  • Helen Marshall, IBCLC says:

    When you say that mothers ” have regular access to a provider trained in lactation support” do you mean the midwife? Sadly this is not accurate. The current (ontario) midwifery program includes NO mandatory breastfeeding training. Some midwifery students chose to do an elective in a breastfeeding clinic however it is often only a day or 2, possibly a week and is observation only. I am in no way criticising midwives, I used them for both my children with great experience but they are not Lactation specialists, they are pregnancy/labour specialists. Only an IBCLC is specifically trained in lactation.

    As a private practice IBCLC, I see first hand how our health care system is failing breastfeeding mothers. I would love to have my services covered by OHIP instead of charging out of pocket , I truly believe that if more IBCLC’s were covered by the health system a lot of money would be saved long term.

  • Laura says:

    Furthermore, the pressure put on women in hospital after birth to breastfeed is far great than healthy eating habits or smoking cessation for other types of patients including cardiac or cancer. Is this right? “Support” is fine but choices need to be available and support offered in a non-discrimatory way.

  • Laura says:

    I received a ton so support for breastfeeding in toronto. In fact it was extremely agressive and disconcerting at the time. I think women have forgot about about our choices here and that for some people it is just ot the right thing. Its sad that women feel the need to put strong pressure on their peers and make them feel inferior/inadequate when it is really up to the mother who is capable of making an informed decision without the overbearing pressure that is typical in many institutions todaty.

  • Jeremy Petch says:

    Correction: This blog incorrectly stated that there is no lead ministry for breastfeeing in Ontario, with responsibility shared between the Ministry of Health and Long Term Care and the Ministry of Health Promotion and Sport. While this was true at one time, the two ministries were merged following the 2011 Ontario election. Reference to the lack of a lead ministry has been removed.

  • Terry Sullivan says:

    A very important topic Karen, vastly underestimated for the scale of life long benefits conferred to breast-fed children. La Leche League Canada (www.lllc.ca) also provides valuable peer support for nursing moms as an international NGO, which could be more actively harnessed in Ontario.

Author

Karen Born

Contributor

Karen is a PhD candidate at the University of Toronto and is currently on maternity leave from her role as a researcher/writer with healthydebate.ca.

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